- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.74 / $154.01 / $187.42
| Facility | | $144.74 | $154.01 | $187.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.10 / $151.15 / $191.71
| Professional | | $136.10 | $151.15 | $191.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $141.06 / $141.06
| Professional | | $141.06 | $141.06 | $141.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.39 / $110.06 / $145.74
| Professional | | $107.39 | $110.06 | $145.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.41 / $160.78 / $266.85
| Professional | | $115.41 | $160.78 | $266.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.16 / $184.27 / $311.27
| Professional | | $134.16 | $184.27 | $311.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.85 / $130.85 / $130.85
| Professional | | $130.85 | $130.85 | $130.85 |